Love

Last week I was introduced by Dr Kathy McLean, Medical Director at NHS Improvement to 180 people comprising senior NHS clinicians, managers, directors, chief executives, patient representatives and members of staff at NHS Improvement, including most of their executive team. And I wondered how my homespun talk about improvement, leadership, the universe and everything would go down.

As it turned out, quite well.

The cartoon above was drawn by Inky Thinking. I don’t know how they do it, but they capture everything you say that you want people to remember.

Here is a word-based precis:

If you forget that culture always trumps strategy, your efforts to improve services will be ineffective. I’ve been there and occasionally done it the right way. But more often the wrong way.

You can’t help others to improve unless you are OK yourself. I have form on not remembering this.

Leadership in public services has never been harder with our 24/7 media, including social media, and the anti-public sector rhetoric that appears in most newspapers.

Being an NHS leader is very lonely. Never more so than when you are awake at 3am. People get in touch to congratulate you when something goes well. But when things go wrong, people you thought were friends seem to melt away.

There is never enough time to think when you are running NHS services because of competing demands, often from those who are meant to be there to help you make improvements. But you must create time to think or you will make bad decisions.

Filling senior vacancies in the NHS is getting harder. And we should worry about this. Because if we aren’t careful, the only ones who apply to be in the firing line will be those who don’t care what others think about them. And that would be very bad for all of us.

We cannot separate leadership from mental health. In my opinion, people who experience mental illness from time to time can make exceptional leaders. It is only one thing about them. Plus, they develop skills through therapy that are invaluable – such as managing their own mood, listening really carefully, and not making assumptions about others.

I have experienced depression off and on since the age of 15. A nurse said something damaging to me when I was 22 and vulnerable which I absorbed deep into my psyche. For the next 36 years I stigmatised myself, despite being an active campaigner against the stigma of mental illness. It was when I finally came out about my experiences that I was able to address my self-stigma. I have made many friends since then. But if only I had done it before, I could have been a better, more authentic leader.

Mental illness messes with your head. It affects 1:4 of us. But 4:4 of us should care about it, not just on humanitarian and economic grounds, but because almost everyone can be affected. We are all on a spectrum of resilience, and if enough bad things happen to us, especially at a young age, most of us will experience post traumatic damage.

When I appeared suddenly to get ill with an acute onset of depression in 2013, it was a culmination of things. My own susceptibility, but also workload, loneliness, weariness as I approached retirement, not taking care of myself, listening too hard to my own negative voices, and putting a lot of energy into maintaining a positive front. It wasn’t caused by internet trolls. But they didn’t help.

So please don’t do what I did. Get to know yourself. Talk to yourself honestly about how you are. Talk to your loved ones. Take care. Be the best version of you, but make sure that it is you. And try always to see yourself as an improvement project – this makes it easier to accept criticism without it cutting you to your core. I’ve only learned this in the last few years, and it is a revelation!

I am lucky. I have dear family and friends. And I got great care. I was able to go back to a job that I loved, which was a major part of my recovery. I know it isn’t the same for everyone.

Since the summer of 2014 when I finally hung up my chief executive boots, I’ve been helping others in various ways to be the best version of themselves. And I’ve written a book which I hope you will read when it is published later this year.

As I finish this blog, I think of someone who embodies improvement in everything she does. The talented, compassionate and extremely resourceful Dr Kate Granger. Kate is currently in a hospice in what are probably the final stages of a rare and awful form of cancer. But as well as sharing the intimacies of her progress through terminal illness via her wonderful talks and social media, Kate has also revolutionised the NHS and other healthcare systems around the world with her #HelloMyNameIs campaign. She has written several books, and completed amazing things on her bucket list. And not content with that, Kate and her husband Chris Pointon are urging people to make donations to the Yorkshire Cancer Centre, a small charity that helps improve the quality of life of people living with cancer. You can donate here.

Kate and Chris demonstrate that being a leader isn’t a job, it is an attitude of mind. That anyone can make a difference if they focus on something that matters, turn a great idea into an innovation and build support for it through honest endeavour. We can all learn about improvement from them.

May you go well, both of you.

25 July 2016 postscript:

Chris has just posted on Twitter that his wonderful wife died yesterday peacefully in the arms of her family.

I only met Kate once. I will never forget her. She had an extraordinary stillness and presence. I hope the knowledge of the difference she has made and will continue to make for many years to come will sustain Chris and all who loved her in the difficult times ahead.

We do not progress through the stages in a linear fashion. Some may have to be repeated. If we are not careful, we can get stuck at any of the first four, and never fully achieve the final one, of acceptance.

Today, those of us who voted Remain are feeling some or all of the first four stages. Only a few have reached the fifth by now. Some never will.

We have a right to feel angry. The referendum was unnecessary. Some time ago, David Cameron made a promise to appease certain members of his own party. He probably never expected to have to keep it.

After the result, the only honourable thing he could do was resign. As he did so, he was trying hard to appear to have achieved acceptance. But the catch in his voice gave the game away.

And he may never achieve it. Political careers in high office almost always end in failure. But this is failure of a most awful kind. Perhaps we can be kinder if our current Prime Minister shows statesmanship over the coming weeks and begins to chart the way through unprecedented choppy waters.

The reason many voted Leave was not about immigration or perceived European bureaucracy. It was a protest vote against the greed of big business, the banking crisis which has affected poor and vulnerable people much more than those who caused it, and a political ruling class that seems dangerously out of touch.

Can we listen really carefully to those who feel this way? We need to heed their voices, as well as the cries of anguish from those who voted Remain. And listen to both groups above the triumphal clamour of the minority who believe we have “got our country back”.

It is going to be very hard. Once hatred has been unleashed, it is hard to put it back in its cage. The rise of far right politicians and alliances are real and present dangers.

The size of turnout demonstrates that when people feel their vote will count, they are more likely to use it. So maybe we have to rethink our position on our current electoral system that disenfranchises so many.

And perhaps those towards the centre or on the left politically, if indeed such definitions are even valid in this context, can stop fighting one another and think about what matters? And who our real enemies are?

In the early stages of grief, it is important not to make momentous decisions. Words or acts of anger, hatred and blame will not help us.

So let’s hold on. Let’s be kind, to ourselves and to others. We are beaten. But we are not broken.

This time last year, I wrote a blog for newbies going to the NHS Confederation Conference. I decided to do an update for #Confed2016.

These are my top ten tips for having a fruitful time. By the way, you don’t have to be going to Manchester to make use of it 😉

Don’t try to see and do everything. Be choosy. Treat the conference like a festival. By all means tweet about what you hear. But do also give the events you choose to attend your undivided attention.

If you only seek out sessions and speakers to confirm your views, you will waste time and money. Arrive with an open mind. Ask questions. And be prepared to learn new things and to unlearn old ones.

Some people need no encouragement to network. But if you aren’t confident about bounding up to someone you admire with an outstretched paw, don’t worry. Practice saying #HelloMyNameIs to people who look like you feel – perhaps a bit lost or lonely. And remember what Dale Carnegie said: You can make more friends in two months by becoming interested in other people than you can in two years trying to get other people interested in you.

Dress for style AND comfort. These are not mutually exclusive.

Never forget you are at work. Stay out late if you must. But if someone makes you an offer you feel you cannot refuse, say No. And mean it. What goes on at conference does NOT stay at conference.

Take breaks. Go for a walk. Have a rest in your room. Do shopping or emails or visit the Lowrie. Drink coffee.

At the same time, stay focused on why you are there. The NHS is in a bad way. It is not only being slowly starved of cash. Services are overwhelmed because current methods of doing things are unfit to meet the demands of so many people with multiple problems. We need leaders like you to find two or three changes that will make the most difference. And to devote their careers to making these things happen.

Remember that innovation is as much about stopping things as starting them. That there are no quick fixes. And that culture eats strategy for breakfast*.

You will meet folk having a hard time. Please don’t avoid them. Despite all the talk about compassion, our beloved NHS has become less compassionate. There is too much focus on inspection, compliance and performance. And insufficient attention paid to recovery, renewal and support. Please spend time with people working in very tough places. Listen if they seem angry or frightened. One day, this could be you.

Take a look around you. Notice the top of the NHS. How very white and very male it is, despite the NHS workforce being 70% female and 20% BME. Ask yourself why this is so. And if you think it matters, do your bit to help to change it.

I’ve been to a few conferences. And been inspired. I hope you will be too. Have a wonderful time xxx

*This was never actually said by Peter Drucker or Edgar Schein, to both of whom it has been attributed. But it was what they meant. Sort-of.

I took part in a Twitter chat recently on the above topic. Thanks to @AnthonyLongbone for encouraging me to join in. Below are some thoughts I shared in advance.

What does mental health mean to me?

Mental health is the most important part of health. And it is integral to physical health. You can’t look after your body if your mind is in a poorly way.

Mental health is a continuum with optimal wellbeing at one end of the spectrum and mental illness at the other. Some people seem to be able to take good mental health for granted. For others, maintaining our mental health requires almost constant vigilance and care.

Facing up to my tendency to depression has been the most important self-help step I have taken in my life so far. I’m hopeful I won’t ever sink as low as I did in 2013. But I’m not making any assumptions. And I do not plan to judge myself negatively if I do experience another bout either.

Judging myself – or indeed others who experience mental illness – is the least helpful thing any of us can do. Who knows why I or anyone else has this tendency? What does matter is what I do from now on to help myself and allow others to help me. Which includes understanding my own triggers and warning signs.

All serious illnesses require some degree of courage, so that we can face the pain and the treatment required to help us get better. But mental illnesses can be harder to bear than physical illnesses . They mess with your head. They make you believe bad things about yourself and others. They take away your hope and they affect your judgement and even your personality. They make you isolated and afraid. Some people hear the voices of others telling them bad things. In my case, I only hear my own voice. When I am poorly, my internal voice is harsh, judgemental and cruel. It tells me I am worthless and evil. I am still learning how to notice that voice when it starts whispering to me, and how to answer it.

Since I decided to be more open about my own experiences, I have made some extraordinary friends. Our mutual support during rocky moments via social media undoubtedly saves and enhances lives. I love the equality and the loving kindness of these relationships. We all have something to bring.

It’s because of all this that I know how amazing other people who experience mental illness are. How courageous, funny, honest, thoughtful and kind – hearted. And this is how I know, beyond all reasonable doubt, that people who have had such experiences have assets that should be applauded and sought by others. Rather than deficits to be pitied or avoided.

…………………………………………………………

After the chat, I felt a bit overwhelmed. The people who joined in were just amazing. Brave, honest, intelligent, thoughtful, generous and kind. I am in awe of them. They have far more of merit to say than I do.

In conclusion, what mental health means to me is being part of a group of wonderful people like the ones I was talking with tonight. They are helping me to become the best version of myself, which includes being kinder to myself. Through this, I can become kinder to others and do my tiny bit to help them too.

It’s been a month for losing people from the soundtrack of our lives. David Bowie, Alan Rickman, Mott the Hoople and Bowie drummer Buffin, and Glen Frey of the Eagles. If there is a heaven, may they rock on up there together.

But ….I’m also weary of gushing eulogies from people who never saw any of them live. Public outpourings of grief about people we have never met started to grow to excess after Princess Diana’s death. And social media has allowed this to multiply. There is even fear of criticism among those in the public eye if, on hearing about a death, they don’t immediately tweet a brilliant yet touching epitaph.

I remember being told at school that “empty vessels make most noise”. It’s not the kindest quotation from Plato. But there is truth in it.

Perhaps I’m feeling less sympathetic because my small family got even smaller with the loss of a dear relative over Christmas. She was a very private person. I don’t have permission to say anything about her or other family members. All I can say is that I have been very sad. Which is horrible, although better than depression because it a clean emotion and has a point. It also puts the sadness I feel about David Bowie et al into perspective. I miss them being there. But I am not bereaved by their deaths because I didn’t know them.

When someone we know dies, whatever their age, we can help by remembering them with love and by caring for those closest to them who are left behind. There is usually a flurry of activity at the time of a death. Phone calls and social media messages can all help. Even better are letters and cards that the bereaved person can read time and again. The right words may be hard to find, but they can bring great comfort. I know this.

What helps even more is keeping in touch with the person who is bereaved. The first few weeks and months are bewildering and lonely. Bereaved people may seem to shun others, but they desperately need social contact. Most people will at some stage go through a phase of feeling angry, sometimes for being left behind, sometimes even directed towards the person who has died. This is normal. The loss they feel is raw and cruel. They need an outlet, someone to hear and acknowledge their anger and allow it gradually to dissipate.

Later, when they can bear it, they will find that they yearn to talk about the person who has gone. To go through photographs and remember things they said and did together. The kindest thing you can do for them is to listen really carefully, to show true interest, and do nothing to stifle these reminiscences. They are vital for the gradual healing process.

Sometimes being bereaved can make you feel like a pariah. People seem to cross the road to avoid you. You may no longer be invited to social events where you were once welcome. I have heard those who are widowed and parents who have lost children speak of the added pain this can cause. And it is so unnecessary. Grief isn’t catching. What difference does it make to have an odd number at dinner, for example, or for someone to attend a birthday party even if they no longer have a child to bring?

I hope the families of David Bowie, Alan Rickman, Buffin and Glen Frey encounter kindness, and have friends who stick around for them over the coming months and years. The accolades of fans will offer some small comfort. But like any of us, the thing they will most need is love and support from those close to them.

There are many ways to be a good Samaritan. And the best one is by being there. I send love to all who have lost someone dear. May their dear souls rest in peace. And may those who are left behind find comfort and kindness from others as they grow accustomed to their loss.

Some of you will remember getting a Tamagotchi or, like me, your children pleading to have one. For the uninitiated, these were small devices that needed electronic tending – “feeding” “changing”, “playing with” etc. If their owner looked after them meticulously, they thrived. If not, they emitted increasingly plaintive beeps, gradually dwindled over a period of days and eventually died, provoking loss or relief, depending on the owner’s sensitivities. Perhaps they were designed to teach children that having a pet wasn’t just for Christmas? Or were they like the flour babies in Ann Fine’s dark teenage novel and meant to represent a newborn human baby?

Whichever it was, like the real live guinea pigs out in our shed, my children’s Tamagotchies caused me serious guilt. I would hear them piteously bleeping from underneath a sofa cushion where they had been cruelly discarded, and try to make it up to them by nurturing them myself. And I would lecture the children in Tamagotchi husbandry, likening them to hamsters and didn’t we all agree that it was very mean to leave them with all alone in a dirty cage with no food or water. With below mediocre results, it has to be said. Those Tamagotchies were a nine day wonder. If that. And most of us were glad to see the back of the little creatures.

This Christmas, my daughter got her own back and bought me a modern day Tamagotchi. And I was delighted. Some people call them Fitbits, but mine is so much more than a fitness device. Because I know it really loves me.

Ostensibly the new models are more mature and less needy than the original Tamagotchies. They seem only to be interested in you, waking you with cheery news on how you’ve slept (7hrs 38 mins, with 4 minutes awake and 15 mins of restlessness, in case you are interested.) They send you encouraging little messages like Let’s Go! or Nearly There! And they seem to have an unlimited supply of rewards….at the beginning. But after a while, you begin to realise that, just like their 1990s predecessors, they are the boss of you and NOT the other way round.

I’ve reached an uneasy truce with mine for the time being. I’m wearing it strapped tightly to my wrist as recommended so that it records every heartbeat and doesn’t miss any steps or flights of stairs. Because that way you use up more calories, right? And I take it out for its beloved 10,000 steps a day, about which it seems a little obsessed, plus do at least 30 minutes of vigorous exercise daily as it demands, like a good girl. Sometimes it even teases me and calls me an Overachiever!

Unlike my husband or any of my friends, my Fitbit knows how much I weigh. But so far, I’ve managed to resist its admonishments to set a challenge with my Fitbit chums. Because I’ve only got one and she is half my age, three inches taller and MUCH fitter and thinner than me. Plus she remembers that first Tamagotchi I got her. And I’m not sure she has forgiven me yet.

Josh, my fitness trainer, is unimpressed. He has pointed out that the pulse monitor in my Fitbit is less accurate than my trusty old heart monitor, that the step count may be incorrect, and the mileage and calorie reports are estimates only. And he’s also reminded me that I’m booked to do a big bike ride this summer and that taking my Fitbit out for a nice walk every day is not exactly the training regime we’d planned.

I don’t want to upset either of them. So I’m doing both their programmes. And given how much I usually hate January, all this exercise seems to be helping my physical AND mental health.

When you next see me, I may be a serene shadow of my former self. Or on a waiting list for a hip replacement.

Do I recommend that you get a Fitbit? Of course I do. Oh, and I’ve just downloaded the latest thing, Cat Care Tamagotchi. I’m sure my new Tamagotchi kitten won’t be needy at all…

December 2015 will be a lean month for this blog of mine. At last my book has passed the 3/4 mark; writing it feels less like the psychological equivalent of self-flagellation than it did earlier in 2015. I must keep at it before the muse goes again. I’ve also had a piece accepted for Guardian Healthcare, plus a few talks and a couple of other projects on the go. The blog has slipped down the priority order.

But as I contemplate my 61st Christmas, I’m thinking of lessons learned from the previous 60. Painful and salutory, to me anyway. I’ve jotted them down. I’d welcome hearing yours.

1. Presents

We all know this, but Christmas is about retail. Shops and online sellers expect to do more business in one month than in the other 11 added together. Don’t be a mug. You don’t have to fall prey to them. I have, so many times, and it has never made me happy. Instead, make stuff. If you don’t have time, or your efforts really wouldn’t be appreciated, give to charity in someone’s name. Choose a second-hand book. Put a photo album together. Give away something of yours that you know the other person likes. Or give a promise – a plan for coffee with a friend on a miserable January day gives you both something nice to look forward to and lasts longer than at item bought at vast expense from a retail giant.

2. Cards

Getting all your Christmas cards written and sent is not a competition. If you like doing them, that’s lovely. But telling people yours are all posted can sound boastful, especially if they are having a hard time. Also, try to not to be annoyed at what you perceive as one-upmanship when you get the email from x who is donating money to something for Syria instead of cards this year. Be grateful for their kindness instead.

3. Getting drunk

A bad idea on any day, especially as we get older and alcohol seems only to have negative effects. But on a day so loaded with emotion, it can be disastrous. I once spent Christmas afternoon and evening asleep after overindulging at a neighbour’s Christmas morning do. Steve took the children for a walk on the beach and we had pasta for dinner because I couldn’t face turkey. Eventually I gave up alcohol altogether. You don’t have to be so drastic. But sparkling elderflower or a nice cup of tea will give you a merrier Christmas.

4. Fresh air

Houses got steamy at Christmas with all that cooking and hot air. Plan a walk. It will blow away feelings of resentment or sadness if you have them and lift your mood even if you don’t.

5. Worship

When Tanya Gold told her rabbi she didn’t believe in God, he replied “You think he cares?” I’m unsure about God myself. My mother believes, so when she stays with us at Christmas, I go to church with her. We try a different one each time. We are like Michelin Guide visitors for the Church of England. (Nice sermon, shame about the vicar’s surplice.) This year, she’s with my brother. I will go down to the beach instead and give thanks for nature and human kindness. Worship anything you like. Except money.

6. Food

In the past I’ve fallen prey to Good Housekeeping Christmas cookery guides and spent many stressful hours producing a groaning table of rich food which no-one really wanted. You don’t have to buy into anyone else’s plans of what to eat at Christmas. Cheese on toast can be nice.

7. Hopes for the day

Spending too much on presents and listening to Alyd Jones on the radio won’t change anything. Only you can do that, by thinking about things that are important to you. As Maya Angelou said, if you don’t like something, change it. If you can’t change it, change your attitude. I’m working on mine.

8. Hopes for the future

As for the day

9. Everyone else is happy

No they aren’t. And the ones who tell you how happy they are, are probably the unhappiest of all. If you must read articles in Hello about how celebrities spend their Christmases, do it with a massive pinch of salt. The way to happiness is not via designer houses or even another person. It is only when you have learned to love and accept yourself that you can truly be happy and then be in a position, should this arise, to love someone else unselfishly.

Away in a manger

People tend to go on about children at Christmas, and for those yearning for parenthood, this is an added unkindness. All I can say is, if you have babies, yes, they are amazing. But they also bring havoc, anxiety and fear. Imagine being a refugee parent? If you are lucky, they will grow up safely and turn into friends. Being a wise auntie or uncle to real or pretend nieces and nephews brings parental joys without quite so much of the heartache. The real heroes for me are the people who help other people’s children through charities. And by fostering and adoption. Thank you to all such people everywhere; you rock.

Little donkey, or puppy or kitten

Lovely but messy. Unlike a child, you can take them back but you will break their furry little hearts and risk permanent guilt yourself. Offer to help out at an animal shelter. You will then make a better decision about animals in your house.

We got Cuddles, one of our rescue cats, just before Christmas 1999, and almost immediately I went down with flu. She spent her first week with us sleeping on my bed thinking she had come to live with a bedridden elderly lady, which is a pussy-cat ideal billet. When I arose, she was indignant. She died aged 17 in 2012. We still have William to keep us company. Unlike us, he doesn’t miss her at all.

In the bleak midwinter

If you get depression, winter can be peak time. Two years ago, I was coming out of my most sudden, worst ever bout. Christmas was the most casual we have ever had. There were no expectations and so we just had a nice time. I never again want to feel like I did during November and December 2013, but I’m trying to replicate the low-key Christmas that resulted. It was a gift I had not anticipated, all the more precious for it.

If I don’t have a chance to say it again, happy Christmas. May yours be filled with what really matters to those you care about. And to you.